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Hypertension associated with anxiety, taken Ciplar La, Telma OD, Amtas, done ECG, renal US, urine test, history of vertigo

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Hi, I am a patient of high blood pressure and 25 years old. It all started like this. I was sufferring from positional vertigo. Vertigo in certain positions of head. I got checked for BP few months back. It was 124/82 one time in emergency. Again after 3 weeks, it was 120/80 in some diff hospital. Next day, a diff doc checked it and it was 145/98. He put me on medication, Ciplar La BD. Then after starting medicaiton, after 4 days since the morning it was feeling heaviness in chest and was having fearful thoughts for almost the whole day. Went to emergency at night, bp was 160/100. After 10 mins wait, it was 150/100. I was given an injection and it came to 120/80 in 20 mins. I was asked to go many tests. 2 ECGs earlier in emergency were normal. Next day, ECG showed probable LVH, right atrial abnormality and some anterior injury. I went echo the same day, it showed everythng normal. Some systolic ejection fraction was 54% which should be 56%. Went to cardiologist and he said everythng is ok with heart. Had renal ultrasounds, showed i have single kidney. Had blood tests for sugar, cholestrol, serume , lipid profile etc and all were normal. In urine routine, protein came high 100mg/dl. Doc said its kidney infection and gave antibiotic for 1 week BD. After that, I had 24 hour protein test it was normal. Since then I had 5 routine urine tests,4 Kidney Function Test all were normal. Doc said i may be having BP from single kidney, and put me on Ciplar LA+Telma OD. My bp started showing low 100/60, sometimes < 100/60. I went to a different doc, he put me on Amtas 5mg, OD. And then one day I had BP of 150/90 and he increased my dosage to 10mg BD. Laster sometime, we and doctor realized that my BP increase happens when I am anxious. Then we reduced dosage and BP continued normal and finally reduced my dosage to 2.5mg, OD. Since then my BP stays around 120-80,130-90. Sometimes, it shows readings < 120/80 and sometimes readings around 140/90. High end readings happen when I am feeling very anxious. I also had my renin level test 1 year which was also normal. Also my bp in doctor's office was 127/70 1.5 months back. In doctor's office, the 1st reading was higher but next reading was 130/80 and 3rd one was 127/70. I have anxiety when I visit doctor because of past experience. Also I monitor my bp daily and it remains within 120-130/80-87 usually. When I am really anxious because of measuring BP, it reaches like 135-140+/80-90. Also 1.5 months back, I had my kidney function test and it was normal. Creatinine, Sodium, Potassium, GFR all were normal. Following are the values by Name, Actual Value, Standard Reference Range:
     Sodium      141      136-147 mmol/L      
     Potassium      4.1      3.5-5.1 mmol/L      
     Chloride      102      98-107 mmol/L      
     CO2      29      21-32 mmol/L      
     Glucose      81      70-100 mg/dL      
     BUN      10      6-25 mg/dL      
     Creatinine      0.9      0.6-1.3 mg/dL      
     GFR Est-Other      >60      >60 See Cmnt      
     GFR Est-African American      >60      >60 See Cmnt      
     Calcium      9.3      8.2-10.2 mg/dL

And very recently I had Protein, Total, Random Urine test and Creatinine, Random, Urine test. The values are
Random Urine Total Protein      9.3      mg/dL
Random Urine Creatinine      42.9      mg/dL

But no standard reference range is given. My primary doctor said its fine. But when I see on internet it says that Protein to Creatinine ratio should be <0.2. But that can be dependent on weight or something. Should I be concerned and go for further evaluation? I am 5'2", 57kg(127 pounds) male 25 years of age. My last conversation with a doctor on XXXXXXX was before the urine test and that can help if you need more context.
Posted Mon, 16 Apr 2012 in Hypertension and Heart Disease
Answered by Dr. Rakhi Tayal 2 hours later
Thanks for writing to us.

The values of random urine protein and creatinine are almost within normal limits and are not worrisome.

The main purpose of this test is to look for proteinuria which is not there in any significant quantities.

Since your hypertension is associated with anxiety it is best to reduce your anxiety by following some lifestyle changes like-

1.Check your caffeine intake-Avoid drinking too much tea, coffee or cola.
2.Avoid alcohol and cigarette smoking.
3.Try physical exercise like aerobic exercises daily for twenty minutes.
4.Avoid your worries and problems or solve them with the help of your family and friends.
5. Learn controlled breathing.
6. Do simple relaxation exercises like yoga, meditation, etc.

You can also discuss the problem with your GP who will help you in choosing a good antianxiety drug with low day time sedation.

I hope my answer and recommendations are adequate and helpful. Waiting for your further follow up queries if any.


Above answer was peer-reviewed by
Follow-up: Hypertension associated with anxiety, taken Ciplar La, Telma OD, Amtas, done ECG, renal US, urine test, history of vertigo 4 hours later
Thanks for your answer. I actually don't drink coffee. Rarely cola like 300ml a week and 1 cup of tea daily. I don't take alcohol and don't smoke. I am also a vegetarian. I jog for 30mins 5 days a week. I do yoga 30 mins daily. My anxiety is usually because of the fear that things might be wrong and I am trying to improve upon that. I used to be very anxious 6-7 months back but hopefully improving and trying to improve now with discipline and better control.
Actually my urine test values were like
100mg/dl 19 months back in random urine test
120mg total in 24 hrs 18.5 months back in 24 hr total urine test
Nil 17 months back in random urine test
Traces 16 months back in random urine test
Nil 16 months back on the next day of the previous test
Nil 13 months back in random urine test
Nil 10 months back in random urine test.
9mg/dl 1 day back in random urine test.

The problem is that I don't understand why protein keep coming sometimes and sometimes in the morning urine, I see more bubbles but as the day progresses and I start drinking water, urine becomes fine which was primarily the reason I went for the urine test. Can it be related to me having single kidney or some problem with the kidney?

Also, I went to a psychiatrist 15 months back and took medications but that didn't improve things as its my fear which keeps me occupied. Then I stopped taking meds and tried to be more disciplined and more control and anxiety improved from there though there is still a long way to go. Like here for a normal person, once doctor said its fine, people will relax and go ahead with their daily routine. But I searched all the stuff on internet and had these thoughts that things are not ideal.My main problem is that 1.5 years back, I never had any medical issue like this and life used to be sort of ideal atleast in terms of health and I always knew that things will become normal. But with these health issues, now I can't say for sure and my mind tries to see ideal things and then relax. Like here if it would have been nil protein, it would have relaxed in peace but since it is not zero but thought sort of fine, it is still worrying.
Answered by Dr. Rakhi Tayal 2 hours later
Thanks for writing again.

I realize this is quite a challenging situation for you and that it is giving you a significant degree of anxiety. There are several categories which we must consider in order to try to figure out what could be contributing to this change in character of your urine.

The first category we should consider is infections. There are certain bacterial and fungal infections which can cause protein excretion in the urine.

If it has not already been done, I would encourage you to obtain a urine culture. This would consist of putting your urine in a culture dish and analyzing it over a few days to see if anything grows. Sometimes a negative urinalysis could still happen in the setting of infection. I suspect that your physician performed a simple urinalysis without culture. If for example the culture did show some type of growth there are good antibiotics and antifungal medications which could eradicate an infection.

We should also try to rule out any changes inside the bladder. Sometimes inflammatory changes of the bladder could lead to changes in the constituents of urine. I would say that if a urine culture is negative for any type of growth then you might need to seek the opinion of a urologist who could analyze your urine for abnormal cells.

The next category would be something like kidney stones. These are tiny solid collections of electrolyte material which can precipitate from time to time. Usually kidney stones are associated with some type of pain so I would consider this less likely in your case. However it still should be considered.

For the time being I encourage you to change your diet to a low protein diet.
Drink plenty of water every day at least six or eight glasses of water I would say.

If your symptoms do not improve with hydration I think you should see the care of your physician for a urine culture. If the urine culture is not revealing I believe you probably should see a urologist.

Wishing you an early recovery.

Above answer was peer-reviewed by
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